Osteoradionekrose der Mandibula

Mandibular
osteoradionecrosis • Osteoradionecrosis of mandible with infection - Ganzer Fall bei Radiopaedia
Hennessy O, Osteoradionecrosis of mandible with infection. Case study, Radiopaedia.org (Accessed on 21 Mar 2023) https://doi.org/10.53347/rID-33514 • CC by-nc-sa 3.0 (modified)
Mandibular
osteoradionecrosis • Mandibular osteoradionecrosis with fracture - Ganzer Fall bei Radiopaedia
Hennessy O, Mandibular osteoradionecrosis with fracture. Case study, Radiopaedia.org (Accessed on 21 Mar 2023) https://doi.org/10.53347/rID-33517 • CC by-nc-sa 3.0 (modified)
Mandibular
osteoradionecrosis • Mandibular osteoradionecrosis with pathological fracture - Ganzer Fall bei Radiopaedia
Knipe H, Mandibular osteoradionecrosis with pathological fracture. Case study, Radiopaedia.org (Accessed on 21 Mar 2023) https://doi.org/10.53347/rID-39583 • CC by-nc-sa 3.0 (modified)
Radiolucent
lesions of the mandible: a pattern-based approach to diagnosis. CT aspect of osteoradionecrosis 5 years after radiotherapy of a floor of the mouth SCC. a OPT. b Axial bone window CT image. c Three-dimensional reconstruction, posterior view obtained after removing the bony structures of the cervical spine. Characteristic osteolytic bone defect (arrows) with poorly defined partly sclerotic margins and soft tissue ulceration (dashed arrow). Follow-up confirmed absence of tumour
insightsimaging.springeropen.com •
Radiolucent
lesions of the mandible: a pattern-based approach to diagnosis. MRI aspect of osteoradionecrosis 2 years after chemoradiotherapy of a tonsillar SCC. a Axial T1-weighted image. b Contrast-enhanced sagittal oblique T1-weighted image and ADC map (small image in b). Bilateral hypointensity of the bony marrow. Large osseous defect with cortical destruction on the left (arrow in a). Marked, non-specific contrast enhancement, bony destruction and necrotic hypointense sequestrae (arrow in b). Note high ADC value (red circle) measured at 1.53 × 10−3 mm2/s suggesting inflammation and absent recurrence. c Macroscopic resection specimen. The necrotic area is indicated by arrows. d Histology (haematoxylin-eosin stain, original magnification 40×): necrotic bone trabeculae with inflammatory infiltrative changes in the bony marrow
insightsimaging.springeropen.com •
Radiopaedia • CC-by-nc-sa 3.0 • de

Mandibular osteoradionecrosis (ORN) is more common after radiation therapy for head and neck malignancies due to the superficial position of the mandible, which exposes it to high radiation. The maxilla can also be involved, but this is less frequent.

Epidemiology

Mandibular ORN may occur in ~20% (5-37%) of patients .

Pathology

Mandibular ORN typically occurs in a patient who has received a dose of >60 Gy . Osteoradionecrosis changes may occur within a year of therapy.

Radiographic features

Features include :

  • cortical destruction that is ill-defined resulting in a mixed sclerotic-lucent pattern
  • sequestration, especially of the buccal bone
  • an absence of soft tissue mass is an important feature to differentiate it from neoplastic recurrence but the presence of soft tissue does not exclude ORN

Treatment and prognosis

Conservative treatment is initially medication only (e.g. pentoxifylline, vitamin E) but more severe cases may require hyperbaric oxygen therapy and/or debridement. Some patients will require resection and reconstruction of the mandible .

Complications

Differential diagnosis

Siehe auch:
Assoziationen und Differentialdiagnosen zu Osteoradionekrose der Mandibula:
Tumoren der
Mandibula
Wikipedia • CC BY-SA 3.0
lytische
Läsionen der Mandibula
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aseptische
Knochenekrose der Mandibula
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aseptische
Knochenekrose der Mandibula bei Bisphosphonattherapie
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